| National Provider Identifier [NPI]: | 1952379588 |
| Last Name Of The Provider | WONG-SICK-HONG |
| First Name Of The Provider | JACKSON |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 350 S 40TH ST |
| Street Address 2 Of The Provider | CCOM MEDICAL GROUP |
| City Of The Provider | MUSKOGEE |
| Zip Code Of The Provider | 744014915 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 108 |
| Number Of Services | 12476 |
| Number Of Medicare Beneficiaries | 1245 |
| Total Submitted Charge Amount | 1805720 |
| Total Medicare Allowed Amount | 574045.13 |
| Total Medicare Payment Amount | 438779.59 |
| Total Medicare Standardized Payment Amount | 479817.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 272 |
| Number Of Medicare Beneficiaries With Drug Services | 78 |
| Total Drug Submitted ChargeAmount | 7696 |
| Total Drug Medicare AllowedAmount | 653.44 |
| Total Drug Medicare PaymentAmount | 600.42 |
| Total Drug Medicare Standardized Payment Amount | 600.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 103 |
| Number Of Medical Services | 12204 |
| Number Of Medicare Beneficiaries With Medical Services | 1245 |
| Total Medical Submitted Charge Amount | 1798024 |
| Total Medical Medicare Allowed Amount | 573391.69 |
| Total Medical Medicare Payment Amount | 438179.17 |
| Total Medical Medicare Standardized Payment Amount | 479217.57 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 287 |
| Number Of Beneficiaries Age 65 to 74 | 381 |
| Number Of Beneficiaries Age 75 to 84 | 375 |
| Number Of Beneficiaries Age Greater 84 | 202 |
| Number Of Female Beneficiaries | 777 |
| Number Of Male Beneficiaries | 468 |
| Number Of Non Hispanic White Beneficiaries | 935 |
| Number Of Black or African American Beneficiaries | 154 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 137 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 732 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 513 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 46 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 41 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 54 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 67 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.9112 |